Estradiol and cognition during androgen deprivation in men with prostate carcinoma.

BACKGROUND: The adverse effects of hormonal manipulation in prostate carcinoma need to be established in view of its increasing use as an adjuvant treatment. This prospective study investigated the association of androgen deprivation-induced estradiol decline with cognition in prostate carcinoma. METHODS: Cognitive testing of prostate carcinoma patients was carried out at baseline and at 6 and 12 months on androgen deprivation (AD). Cognitive performances were evaluated with standardized measures of information processing, including working memory and attention, visual and verbal skills, and memory performances in 31 tests. Testosterone and estradiol changes during AD were measured with the DELFIA (PerkinElmer, Inc., Wellesley, MA) system. Associations between changes in cognitive performances and estradiol decline were studied. RESULTS: Cognitive performances, which were significantly associated with decline in estradiol, included visual memory of figures (r = -0.52; P = 0.022) and recognition speed of numbers, which were impaired, (r = -0.57; P = 0.030) at 6 months, and improvement in verbal fluency (r = -0.52; P = 0.019) at 12 months. Other cognitive domains appeared unaffected by estradiol decline. The character of change (impairment or improvement) depended on the magnitude of estradiol decline. CONCLUSIONS: The cognitive domains of verbal fluency, visual recognition, and visual memory were associated with decline in estradiol during androgen deprivation. The results suggest selective associations among testosterone decline, estradiol, and cognitive performance. Documentation of these associations has implications for informed patient support in hormonally treated prostate carcinoma.

Short-term effects of radiotherapy on attention and memory performances in patients with brain tumors.

BACKGROUND: The objective of the current study was to evaluate the short-term effects of radiotherapy on attention and memory performance in patients with brain tumors. METHODS: Thirteen patients underwent a neuropsychologic examination on three occasions: at baseline before radiotherapy, which lasted for 6 weeks; within 2 weeks after the completion of radiotherapy; and 3 months after the completion of radiotherapy. Thirty healthy individuals were studied at baseline as a control group. Verbal, visuomotor, and memory tests were administered. Attentional performances were examined using CogniSpeed reaction time software. RESULTS: At baseline, the patients scored significantly lower than the controls in tests of semantic memory (Similarities; P = 0.002), visuoconstructive skill (Block Design; P = 0.028), and visual and verbal memory (recall of 20 objects: immediate, P = 0.017; delayed, P = 0.002; recall of 30 paired word associates: immediate, P = 0.002; delayed, P = 0.005). The patients performed significantly more poorly than the control group on the Two-Choice Reaction Time test (P = 0.047), the Subtraction test (P = 0.042), and the Vigilance test (P = 0.023). After radiotherapy, the performance of the patients did not worsen on any measure, whereas their conscious cognitive processing was improved (P = 0.002). CONCLUSIONS: Treatment with radiotherapy did not cause negative short-term effects on attentional and memory functions in patients with brain tumors who received a radiation dose of 54.5 grays. The cognitive deficits found in these patients were evident at baseline before radiotherapy. Thus, it seems likely that the deficits were associated with the tumor itself and/or the surgical procedures.